{
"Npi": {
"NPI": "1982818399",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUL SHINE CHILDREN'S TREATMENT SERVICES, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1546",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PEMBROKE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28372-1546",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-536-6094",
"MailingAddressFaxNumber": "910-843-9728",
"FirstLinePracticeLocationAddress": "218 E 2ND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RED SPRINGS",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28377-1308",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-536-6094",
"PracticeLocationAddressFaxNumber": "910-843-9728",
"EnumerationDate": "05/09/2007",
"LastUpdateDate": "07/09/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEESE",
"AuthorizedOfficialFirstName": "LESHIA",
"AuthorizedOfficialMiddleName": "ROGERS",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "910-536-6094",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "LCAS-21969",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "C005175",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}